Alpert Medical School of Brown University, Bradley/Hasbro Children's Research Center.
J Pediatr Psychol. 2018 Oct 1;43(9):943-954. doi: 10.1093/jpepsy/jsy027.
Common comorbid medical conditions including allergic rhinitis (AR), obesity, and sleep disordered breathing (SDB) have been linked with asthma exacerbations; however, these conditions also impact sleep and academic functioning. The current study sought to examine unique and combined associations of these common comorbidities on sleep and academic performance among urban minority children with persistent asthma. We expected additional comorbid diagnoses would be associated with poorer sleep and academic functioning.
Urban children 7-9 years old (n = 249) with persistent asthma from African American, Latino, and non-Latino White backgrounds participated in this cross-sectional study. Asthma and AR were assessed using guidelines-based approaches. Overweight/obesity was assessed using body mass index and parents reported on SDB risk. Sleep quality (sleep efficiency) and sleep duration were assessed via 4 weeks of actigraphy. A cumulative risk index (CRI) score of asthma-related comorbidities (i.e., number of comorbidities for which each child met criteria) was calculated.
Comorbid conditions were prevalent (AR, 85%; overweight/obese, 39%; SDB risk, 44%). Lower SDB risk and better AR control were both associated with fewer school absences. A higher CRI score was associated with shorter sleep duration and more absences. For children with 1 comorbid condition, better lung function was associated with better sleep efficiency.
Findings suggest increased risk of shorter sleep and more frequent school absences among urban minority children with asthma and more comorbid conditions. Assessment and treatment of this high-risk group must consider how comorbid conditions exacerbate children's asthma and may affect sleep and daytime functioning.
常见的合并医学病症，包括过敏性鼻炎（AR）、肥胖和睡眠呼吸紊乱（SDB），与哮喘加重有关；然而，这些病症也会影响睡眠和学业功能。本研究旨在检查这些常见合并症对城市少数族裔持续性哮喘儿童睡眠和学业表现的独特和综合影响。我们预计额外的合并症诊断将与较差的睡眠和学业功能相关。
本横断面研究纳入了来自非裔美国人、拉丁裔和非拉丁裔白人背景的 7-9 岁城市儿童（n=249），这些儿童患有持续性哮喘。哮喘和 AR 采用基于指南的方法进行评估。超重/肥胖采用体重指数评估，父母报告 SDB 风险。通过 4 周的活动记录仪评估睡眠质量（睡眠效率）和睡眠时间。计算与哮喘相关的合并症的累积风险指数（CRI）评分（即每个孩子符合标准的合并症数量）。
合并病症普遍存在（AR，85%；超重/肥胖，39%；SDB 风险，44%）。较低的 SDB 风险和更好的 AR 控制都与较少的缺课天数相关。较高的 CRI 评分与较短的睡眠时间和更多的缺课天数相关。对于有 1 种合并症的儿童，更好的肺功能与更好的睡眠效率相关。
研究结果表明，患有哮喘和更多合并症的城市少数族裔儿童更有可能出现睡眠缩短和更频繁的缺课现象。对这一高风险群体的评估和治疗必须考虑到合并症如何加重儿童的哮喘，并可能影响睡眠和白天的功能。
